Which One is Better? Comparison of the Acute Inflammatory Response, Raja Isteri Pengiran Anak Saleha Appendicitis and Alvarado Scoring Systems

Abstract

PurposeAcute appendicitis (AA) is one of the most common causes of an acute abdomen. The accuracies of the Alvarado and the acute inflammatory response (AIR) scores in the diagnosis of appendicitis is very low in Asian populations, so a new scoring system, the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) system, was designed recently. We applied and compared the Alvarado, AIR, and RIPASA scores in the diagnoses of appendicitis in the Iranian population.MethodsWe prospectively compared the RIPASA, Alvarado, and AIR systems by applying them to 100 patients. All the scores were calculated for patients who presented with right quadrant pain. Appendectomies were performed; then, the postoperative pathology reports were correlated with the scores. Scores of 8, 7, and 5 or more are optimal cutoffs for the RIPASA, Alvarado, and AIR scoring systems, respectively. The sensitivities, specificities, positive predictive values, negative predictive values (NPVs), positive and negative likelihood ratios (LRs) for the 3 systems were determined.ResultsThe sensitivity and the specificity of the RIPASA score were 93.18% and 91.67%, respectively. The sensitivities of the Alvarado and the AIR scores were both 78.41%. The specificities of the Alvarado and the AIR scores were 100% and 91.67%, respectively. The RIPASA score correctly classified 93% of all patients confirmed with histological AA compared with 78.41% for the Alvarado and the AIR scores.ConclusionThe RIPASA scoring system had more sensitivity, better NPV, a positive LR, and a less negative LR for the Iranian population whereas the Alvarado scoring system was more specific.

Diagnostic Scores in Acute Appendicitis

“…Goel et al [11], in India, evaluated the efficacy of the Alvarado score and the RIPASA score finding that the Alvarado score has a better specificity than the RIPASA score (100 vs. 50%) and also a better negative appendectomy rate (0 vs. 5%). Similar results were reported by Karami et al [12], in Iran, who found that the Alvarado score was 100% specific as compared with the RIPASA and the AIR scores (91.6% for both).…”

Alvarado and Appendicitis Inflammatory Response Scores Can Evaluate Severity of Acute Appendicitis?

“…The AIRS uses the symptoms of vomiting, pain in the RIF, signs of abdominal defense, and a temperature >38.8°C, in addition to laboratory values indicating segmented neutrophils, and leukocyte and CRP values. [7] The AS and the AIRS criteria are illustrated in Table 1 and Table 2.…”

“…The diagnosis sensitivity of the Alvarado score (AS) has been reported as 78.41%, the Appendicitis Inflammatory Response score (AIRS) as 78.41%, and the Raja Isteri Pengiran Anak Saleha Appendicitis scoring system (RIPASA) as 93.18%, while the diagnosis specificity has been reported as 100%, 91.67%, and 91.67%, respectively. [7] The severity of AA is generally evaluated radiologically. The white blood cell (WBC), CRP, and total bilirubin values, the neutrophil-to-lymphocyte ratio, and the combination of radiology and laboratory scoring systems are used for severity evaluation.…”

Preoperative prediction of complicated appendicitis using machine learning method

“…Under resource limited conditions, sophisticatedly and fully considering of clinical symptoms, signs and blood biomarkers could potentially help medical practitioners in decisionmaking for acute appendicitis patients [32]. And the biomarkers of blood in ammation are of great value in the diagnosis and pathological classi cation of acute appendicitis [20,21,33]. AI-assisted diagnosis of acute appendicitis may help clinicians to make better decisions.…”

“…Therefore, the timely diagnosis of acute appendicitis or even its pathological type through clinical manifestations and laboratory examinations become challenging but necessary. Several scoring systems have been developed to help clinicians with diagnosis of acute appendicitis, including the Alvarado, the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) and the acute in ammatory response (AIR) scoring systems [17][18][19][20][21]. AIR is an index of acute in ammatory responses based on the Alvarado Score, which improves the accuracy of the diagnosis of acute appendicitis.…”